Benefits Open Enrollment
Changes to employee selected optional benefits can only be made when the employee experiences a "Major Life Event" or during "Annual Benefits Open Enrollment". Changes made during the 30 day open enrollment period are effective during the next plan year. Annual Open Enrollment is typically mid-April through Mid-May, and the UA benefit plan year is July 1 - June 30.
Major Life Event:
Outside of the annual open enrollment period, and employee may change an enrollment election (i.e., add or delete dependents, change level of coverage) only if there has been a Major Life Event. The following are considered major life events:
- Marriage or divorce of the employee
- Death of the employee’s spouse or a dependent
- Birth or adoption of a child by the employee
- Termination of employment (or the commencement of employment) of the employee’s spouse
- Switching from part-time to full-time employment status or from full-time to part-time status by the employee or the employee’s spouse
- Taking of an unpaid leave of absence by the employee or the employee’s spouse
- A significant change in the health coverage of the employee or the employee’s spouse attributable to the spouse’s employment
- Gain or involuntary loss of health care coverage of your dependent
- Loss of coverage due to less than full-time student status, and regaining eligibility due to full-time student status
The list below may assist you in understanding what types of changes you may need to make, or consider making and provides many of the forms you need to submit changes. Please be advised that changes which alter your level(s) of coverage (i.e.: health insurance, life insurance, AD&D, reimbursement accounts, etc) must be received by Human Resource Services within 30 days of the major life event date with the exception of adding a newborn which can be done up to 60 days after birth. Note: adding or removing a dependent to/from the UA health plan must be accompanied by a certifying document such as: a copy of the birth certificate, marriage certificate/divorce decree. If you do not have one of the documents noted above as proof of your life event do not delay submitting your election changes, contact UAA HR to find out what alternative documents may be provided in lieu of the ones listed here.
- UA Choice Opt Out Form
This form is required in addition to the UA Choice
Health Enrollment/Drop form to opt out of health
- Statement of Financial Interdependency Form,
Required to document a Financially Interdependent
Partner (FIP) relationship. This form is required in
addition to the UA Choice Health Enrollment Form
to add a (FIP) to the health plan.
- Financial Interdependent Relationship Explanation
- Declaration of Termination of Financial Interdependent Relationship
Required to document the termination of a Financially
Interdependent Partner (FIP) relationship in addition
to the UA Choice Health Enrollment Form to drop a
(FIP) from the health plan
- UA Choice Supplemental Benefits Election Form
Use to start/stop/change FSA and/or Life Insurance
- Evidence of Insurability Enrollment (EOI) Form
(Note: Electing any life insurance amount over
$200,000 requires evidence of insurability (EOI).
You must complete the EOI form and submit it along
with your election form if you wish to elect
more than $200,000 in supplemental life Insurance.
If denied, supplemental coverage will be limited to no
more than $200,000.
- Beneficiary Form for UA Life Insurance
- Beneficiary Form Website for TRS/PERS
Use this website to locate the correct forms to
designate your PERS or TRS beneficiary
- Beneficiary Designation for UA ORP, TDA and/or UA Pension
You must contact the appropriate vendor directly:
Fidelty Beneficiary Form or call (800) 343-0860
Valic, call (907) 279-8302
TIAA-CREF, call (800) 842-2007
Lincoln National, call (800) 348-1212
- W4 Form, 2012
To change tax withholding elections
- UA Change form
(To change address, name, or marital status)
Updates UA, PERS/TRS, Premera Blue Cross
CareMark (prescription) and VSP (vision) only.
To update address with ORP or UA Pension vendor,
contact the vendor directly)
Still have questions? Send us an e-mail.